A 10-Year Follow-Up of a Randomized Prospective Study of 2 Treatments for Chronic Rhinosinusitis Without Nasal Polyps and Investigation of the Impact of Gastroeosophageal Reflux Disease in the Resistance to Treatment.

OBJECTIVES: To compare the 2 long-term medical strategies in chronic rhinosinusitis without nasal polyps (CRSnNP) and to identify the role of gastroesophageal reflux disease (GERD) and Helicobacter pylori as factors of treatment failure. MATERIAL AND METHODS: Fifty-seven patients with CRSnNP were randomized into 2 therapeutic groups. The first group was treated with 4 weeks of amoxicillin/clavulanate and a short course of oral steroids. The second group received 8 weeks of clarithromycin. Sinonasal Outcome Test-20 (SNOT-20) and Lund and Mackay scores were assessed at baseline and after treatment, and GERD Health-Related Quality of Life (GERD-HRQL) questionnaire was evaluated in all patients. Patients with a GERD-HRQL score >8 received esogastroscopy and H pylori detection. Patients were followed during a 10-year period for clinical course and GERD evolution. The 10-year evolution of patients was described in terms of recurrence, medical, and surgical treatments. RESULTS: Thirty-seven patients completed the study; SNOT-20 and Lund and Mackay scores similarly improved in both groups. Amoxicillin/clavulanate group had significantly more adverse reactions than the clarithromycin group (P = .03). After the therapeutic course, 35% (amoxicillin/clavulanate) and 41% (clarithromycin) of patients needed functional endoscopic sinus surgery (FESS). During the long-term follow-up, 54% (amoxicillin/clavulanate) and 40% (clarithromycin) of patients had late CRSnNP recurrence; FESS was performed in less than 15% of cases of recurrence. Gastroesophageal reflux disease complaint's severity was associated with late recurrence of CRSnNP. CONCLUSION: Amoxicillin/clavulanate and clarithromycin would be competitive treatments for CRSnNP. Gastroesophageal reflux disease seems to be a negative factor for treatment response and recurrence.

Clinically unsuspected tonsillar sarcoidosis in a child revealed by routine histologic examination.

In most hospitals, making a microscopic examination to tonsil and adenoid specimens from pediatric patients who present recurrent infections has become a standard practice. However, studies have shown that systematic examination of tonsils and adenoids was not needed for individual aged 21 or less. In this context, we describe the third report of an unsuspected tonsillar sarcoidosis revealed by histologic examination. A 5-year-old white girl was referred to our department because of frequent nasal and pharyngeal infections. Both tonsillectomy and adenoïdectomy were performed. Histologic evaluation revealed noncaseous epithelioid granulomas morphologically compatible with a diagnosis of sarcoidosis. Our observation illustrates the benefit of histological analysis in every tonsillectomy and adenoïdectomy specimen.

Aggressive pilomatrixoma of the infra-auricular area: a case report.

Although pilomatrixomas are well known among dermatologists and dermatopathologists, head and neck surgeons confronted with these lesions in the infra-auricular region do not consider this benign neoplasm in the differential diagnosis. Aggressive pilomatrixoma is a benign tumor of the hair matrix cells affecting mainly children. Histologically, the border between aggressive pilomatrixoma and pilomatrix carcinoma is still not clear. We report the case of a 15-year-old Turkish boy suffering from an aggressive pilomatrixoma of the infra-auricular region and review the literature about this unclear entity.

Galectin-8 up-regulation during hypopharyngeal and laryngeal tumor progression and comparison with galectin-1, -3 and -7.

AIM: To define specific staining patterns for the adhesion/growth-regulatory lectin tandem-repeat-type galectin-8 in hypopharyngeal and laryngeal tumor progression and relate these parameters to galectins 1, 3 and 7 in the quest to explore the galectin network. MATERIALS AND METHODS: The level of expression of galectin-8 was determined immunohistochemically in a series of 18 and 16 cases of tumor-free epithelium, 24 and 10 cases of low-grade dysplasia, 22 and 15 cases of high-grade dysplasia located in peri-tumoral area of 74 and 37 hypopharyngeal and laryngeal carcinomas. RESULTS: Marked upregulation in galectin-8 staining intensity and immunopositive area in malignancy versus dysplasia was seen in hypopharyngeal cancer (p<10(-6)), in laryngeal cancer for labeling index and high-grade dysplasia/carcinoma (p<10(-6)). No correlation to recurrence was delineated. CONCLUSION: The presented data revealed a divergence within the galectin-1, -3, -7 and -8 network during tumor progression.

Galectin-3 upregulation during tumor progression in head and neck cancer.

OBJECTIVES/HYPOTHESIS: To examine the level of expression of galectin-3 in relation to neoplastic progression of hypopharyngeal squamous cell carcinomas (HSCCs) and laryngeal squamous cell carcinomas (LSCCs). STUDY DESIGN: Retrospective study. METHODS: Using a polyclonal antibody against galectin-3 without cross-reactivity to other galectins, we analyzed the presence of galectin-3 using quantitative immunohistochemistry in i) a series of 79 HSCCs compared with 16 normal epithelia, 20 low-grade dysplasia (Low_D) and 25 high-grade dysplasia (High_D) and in ii) a series of 58 LSCCs compared with 34 normal epithelia, 12 Low_D, and 18 High_D. In parallel, galectin-3 expression was studied using Western blotting on a series of 19 fresh biopsies from patients presenting a head and neck tumor. RESULTS: Western blotting excluded a notable degree of proteolytic truncation of galectin-3 in situ. Immunohistochemical galectin-3 positivity expressed as percentage of cells was significantly higher in LSCCs and HSCCs than in Low_D (P = .01) or High_D (P = .0002), respectively. Increased expression of galectin-3 in HSCCs was accompanied by a shift from the cytoplasmic compartment to the nucleus (P = .007). In intertumor-type comparison, laryngeal carcinomas presented nuclear presence of galectin-3 only rarely (1 of 58 cases in laryngeal cancer vs. 27 of 79 cases in hypopharyngeal cancer, P = .00006) and a comparatively low labeling index (P < 10(-6)). CONCLUSIONS: Our data reveal an association between level of presence of galectin-3 and neoplastic progression of HSCCs and LSCCs.

Schwannoma of the accessory phrenic nerve.

Otolaryngologists are frequently confronted with the management of cervical tumors. Neurogenic tumors concern, especially, the cranial, sympathetic, or peripheral nerve sheathes. These tumors are benign and grow slowly. The involvement of the cervical part of the phrenic nerve is exceptional, and only 2 cases are reported in the literature. We describe the first case of a cervical schwannoma involving the accessory phrenic nerve. The anatomy and function of the accessory phrenic nerve are reviewed.